The Myth of Patient Consumerism

The newest mantra in sick care is patient empowerment to make them effective consumers of care. The underlying assumption seems to be that by giving them the information they need, patients will make sick care decisions, and even health care decisions, that are not only in their own best interests, but, in so doing, in the interests of the society at large. Doctors are being asked to do the same thing. Unfortunately, it is virtually impossible to serve three or four masters. The problem is that asking patients to shop for care does not work.

We are a long way from true patient choice, and we may never get there, for several reasons:

1. Insurance constraints and limitations.
   
   
2. Inaccurate or unavailable true cost and quality outcomes data.
   
   
3. Like all consumers of anything, they buy emotionally, perturbed by bias, and justify rationally.
   
   
4. Lack of access due to geographic maldistribution.
   
   
5. Lack of competition.
   
   
6. The moral hazard of third party reimbursement.
   
   
7. The difference between the quality of experience and service and the quality of care and the unrelatedness of the two.
   
   
8. Patient variation contributing to disparity of outcome.
   
   
9. Social determinants contributing to disparity of outcomes.
   
   
10. Low patient health and insurance IQs interfering with their ability to make smart choices.
    
    
11. Lack of sick care competition and the biomedical complex and vested interests rigging the system to prevent price competition and quality comparison.
    
    
12. Rules and regulations designed to prevent competition.
    
    
13. In many instances, patients are not in a situation where they have the ability or emotional state to make rational purchasing decisions.
    
    
14. Confronting the power imbalance between the doctor and the patient and the fear of retribution if the patient overrides a doctor recommendation, no matter how wasteful on potentially harmful.
    
    
15. Many patients simply don't want to do it and would rather just do what their doctor tells them to do.
    
    
16. Patients don't trust the information they get.
    
    
17. Generational buyer habit differences.
    
    
18. Psychographic buying habit differences. For example, Deloitte has identified six unique segments that comprise the health care consumer market – each segment approaches decisions about health, health care, and health insurance in a distinctive way.
    
    
19. Inability to target and change the behavior of the 5% who account for 50% of the spend.
    
    
20. Lack of incentives for both the doctor , the patient and the payer to save aggregate costs unless it directly benefits them.

Part of the problem is how we define "consumer" and how the actors engage in the play. Doctors are purchasing agents/influencers that make recommendations to the patient. The patient is the end user. Between the two are the people who actually pay for the tests, drugs, devices and procedures. If you are a sick care entrepreneur, you need to take this into consideration when you are doing customer discovery and trying to find early evangelists to help launch your product.

Yes, patients can make choices when it comes to elective, cash based care, and they do . They also make choices based on their perception of the quality of service, bedside manner and experience, most of which have little or no correlation with the quality of care.

The most expensive piece of technology in sick care is a doctor's mouse. Nothing gets done or ordered, aside from DIY medicine, which comes with its own poor choice perils, unless the doctor orders it. It is up to doctors to make smart choices in most instances, not the patient, and it will take substantial effort to change their behavior. We should concentrate on making doctors better purchase agents, and less about making patients better end users.

There is a lot of pain in the US sick care experience for most patients But, like going to an endodontists to get a root canal , there is a lot they can do to eliminate the pain and make the experience much more pleasurable. It doesn't do much good, though, if the dentist did the wrong thing or did it the wrong way or you responded to the treatment in such a way that your tooth died or fell out. But at least Dr. Endo got great Yelp reviews.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs.